tbuckley/cabot-search huggingface dataset:
Abstract 12743: Patient Satisfaction and Determinants of 1-Year Mortality Following Acute Coronary Syndrome
Authors: Sujaytha Paknikar, Marlene Girardo, Sean Legler, Samia Mora, Alawi Alsheikh-Ali, Sagar Dugani, Mohammed Zubaid
Journal: Circulation (2022)

Introduction: The association of patient satisfaction with hospital ACS care and risk for long-term outcomes is incompletely described. This is particularly relevant to the Gulf region, where the ACS burden is high and literature on patient satisfaction and outcomes is lacking. The aim was to compare determinants of 1-year mortality based on patient satisfaction with ACS care in the Gulf region. Methods: In a prospective registry of 3566 ACS patients from Bahrain, Kuwait, Oman, and UAE (Gulf COAST registry), we grouped patients by their self-reported overall satisfaction with ACS care reported at 1-month following ACS (low satisfaction [n=1654] vs. high satisfaction [n=1912]; Table). We examined associations of baseline characteristics and risk for 1-year mortality in logistic regression models adjusted for Global Registry of Acute Coronary Events (GRACE) score. Results: Mortality at 1-year following ACS was higher in patients reporting low satisfaction (8.8%; n=146/1654) vs. high satisfaction (5.4%; n=103/1912) ( P &lt;.0001). Women, compared with men, had higher 1-year mortality risk in both satisfaction groups, and statistically significant risk in the low satisfaction group (aOR 1.45 [1.01–2.07]; P &lt;.05). Lack of employment (vs. any employment) was associated with higher 1-year mortality risk in both the low satisfaction (aOR 6.44 [2.58–16.03]) and high satisfaction (aOR 2.58 [1.35–4.93]) groups with borderline significant interaction ( P interaction = .08). In both satisfaction groups, lack of education, hypertension and prior angina were associated with higher 1-year mortality risk, whereas dyslipidemia and diabetes showed no association. Conclusions: Low patient satisfaction with ACS care was associated with higher 1-year mortality risk. Socioeconomic factors such as employment and education were associated with higher 1-year mortality, independent of patient satisfaction, and may guide mortality reduction interventions.
Abstract 14042: Cmr Demonstrates Key Differences in Patients Undergoing De Novo CRT versus CRT Upgrades
Authors: Kenneth C Bilchick, Derek Bivona, Frances Morales, Mohamad Abdi, Yu Wang, Pim Oomen, Xu Gao, Rohit Malhotra, J. M Mangrum, Andrew Darby, Oliver Monfredi, Nishaki M Mehta, Pamela Mason, Sula Mazimba, Christopher M Kramer, Frederick H Epstein
Journal: Circulation (2022)

Introduction: Patients with cardiac resynchronization therapy (CRT) upgrades with right ventricular pacing (RVP) dependence may have a different prognosis after CRT and require a distinct implementation strategy. Hypothesis: Left ventricular (LV) size/function, optimal AHA segments for LV pacing, and survival post-CRT is different for patients with RV pacing undergoing CRT upgrade procedures. Methods: Cardiac magnetic resonance (CMR) with cine imaging, DENSE strain mechanical activation mapping, and scar imaging was performed prior to implants of CRT systems that were "de novo" (Group 1) or upgraded from pre-existing pacemakers or ICDs with RVP (Group 2) and without RVP (Group 3). Optimal LV pacing sites were identified based on latest activation. Patients were followed for clinical outcomes. Results: In 92 patients (23.5% female, 65.8 ± 10.7 years old), the baseline LVEDVI by CMR was significantly smaller in RVP upgrade (Group 2) patients (101.8 +/- 34.3 cc/m 2 ) compared with de novo (Group 1; 140.5 +/- 38.2 cc/m 2 ); p=0.001) and non-RVP upgrade patients (Group 3; 153.6 +/- 46.4 cc/m 2 ; p=0.001) (Figure 1). RVP upgrade patients also had the widest baseline QRS (178.2 +/- 26.6 ms v. 159.7 +/- 18.5 ms in Group 1 v. 154.5 +/- 20.1 ms in Group 3; p = 0.001) and were more likely to have latest mechanical activation in an anterior LV segment (50%) versus Group 1 (10%) and Group 3 (35%) patients (p = 0.0007). As shown in Figure 2, RVP upgrade patients had the worst survival (p = 0.007). Conclusion: Patients with RVP dependence undergoing CRT upgrades are more likely to have smaller baseline LV volumes by CMR, greater QRS durations, optimal pacing sites in anterior segments, and unfavorable survival.
Abstract 14167: Safety Profile of Leadless Pacemaker in Comparison to Conventional Transvenous Pacemaker: A Systemic Review and Meta-Analysis
Authors: Jurgen Shtembari, Dhan B Shrestha, Shila Awal, Anuradha Raut, Pratik Gyawali
Journal: Circulation (2022)

Introduction: Recently, there has been a dramatic surge of interest in leadless pacemakers (LP). Although benefits of LP versus transvenous pacemakers (TVP) have been reported in small institutional and some registry-based studies, the systematic comparison and pooling of data remain limited. Therefore, we sought to meta-analyze the safety and benefit of leadless pacemakers over conventional transvenous pacemaker systems. Method: We followed PRISMA guidelines to conduct the study. The study protocol has been registered in the PROSPERO (CRD42022325376). Databases were searched for published literature from inception to April 12, 2022. Comparative studies on TVP with LP reporting device-related, cardiac, vascular, thoracic complications, and infection were included. Studies were analyzed using RevMan 5.4.1 with odds ratios (OR) to assess overall complications, device dislodgement, reintervention, and other complications. The I-squared (I 2 ) test was used to assess the heterogeneity. Result Total 879 studies were imported from databases. After the removal of 265 duplicates, 614 papers were screened for eligibility. Among 41 papers screened for full text, 17 meet the inclusion criteria. There were 50% lower odds of overall complications in the LP group (OR 0.50, 95% CI 0.32 to 0.78; n = 20825). Similarly, 73% lower odds of device dislodgment (OR 0.27, 95% CI 0.14 to 0.50; n = 6897), 46% lower odds of re-intervention (OR 0.54, 95% CI 0.45 to 0.64; n= 17009), 87% lower odds of pneumothorax (OR 0.13, 95% CI 0.03 to 0.57; n = 4261), however 2.08 higher odds of pericardial effusion (OR 2.08, 95% CI 1.04 to 4.16; n = 4842) observed in LP group. Conclusion Meta-analysis of observational studies suggests that LP demonstrates a more favorable complication profile than TVP, although with higher rates of pericardial effusion. However, patient selection was not uniform between studies, and inferences remain limited.
Abstract 13540: Characteristics of Home-Based Walking Exercise Interventions Associated With Greater Improvement in Walking Performance in Peripheral Artery Disease: A Post-Hoc Analysis of the HONOR Randomized Clinical Trial Results
Authors: Madeline Cetlin, Dongxue Zhang, Lu Tian, Lihui Zhao, Mary M McDermott
Journal: Circulation (2022)

Introduction: Benefits of home-based exercise (HBE) interventions in lower extremity peripheral artery disease (PAD) are variable. This post-hoc analysis of the HONOR randomized trial studied characteristics of a home-based exercise intervention associated with greater 6-minute walk improvement in PAD. Methods: HONOR was a multi-centered randomized trial. PAD participants were randomized to either a HBE intervention or usual care for 9 months. The intervention consisted of four weekly in-person visits with an exercise coach followed by 16 telephone coaching calls over the next eight months. Participants were asked to walk for exercise five days/week, wear a Fitbit to monitor activity, upload their Fitbit on the study website, and visit the website at least weekly to view their exercise goals and monitor their progress toward exercise goals. The primary outcome was change in 6-minute walk distance at 9-month follow-up. Results: Of 200 people randomized (age 70 yrs. ±10.4, 52.5% female, 50% Black), 182 (91%) completed nine-month follow-up. Overall, the exercise intervention did not improve 6-minute walk compared to usual care [+5.5 vs. +14.4 m respectively (Mean diff: –8.9 m, 95% CI, –26.0, +8.2 m, P = .31)]. Among the 99 people randomized to HBE, change in 6-minute walk ranged from -239.2-233.7. See table for characteristics associated with greater six-minute walk improvement. Conclusion: In a home-based exercise intervention for PAD, more frequent use of the intervention website and greater exercise sessions/week, but not more time wearing a Fitbit, were associated with greater 6-minute walk improvement. Future home-based exercise interventions for PAD should help patients self-monitor exercise behavior and increase exercise sessions per week.
Abstract 12938: Intrathoracic Visceral Adiposity is Inversely Associated With Insulin Like Growth Factor Binding Protein 1: The Longenity Study
Authors: Rohan A Kankaria, Kenny Ye, Leandro Slipczuk, Damini Dey, Jeffrey M Levsky, Nir Barzilai, Sofiya Milman, Anna E Bortnick
Journal: Circulation (2022)

Introduction: Higher insulin-like growth factor binding protein 1 (IGFBP-1) level in serum has been variably associated with better insulin sensitivity and lower rates of obesity, diabetes mellitus, and atherosclerosis; suggesting that it may have a protective role in cardiometabolic aging. We hypothesized that epicardial, intrathoracic, or total thoracic adiposity (EAT, IAT, or TTA, respectively) measured on thoracic CT, were inversely associated with IGFBP-1, providing an assessment of cardiometabolic status by computed tomography (CT). Methods: Participants (n=104) were prospectively enrolled from the LonGenity study at Albert Einstein Institute of Aging. Participants were of Ashkenazi descent and ≥65 years, 53% were offspring of parents with exceptional longevity (OPEL) and 47% were offspring with usual survival (OPUS). Exclusion criteria were prior coronary artery bypass or stent, heart rate &gt; 100 beats/minute or not in sinus rhythm. Participants underwent a non-contrast gated CT. Adiposity was quantified using QFAT software (Cedars Sinai, CA). IGFBP-1 measures closest to the CT were used, ranging from 58 months before to 16 months after, with the majority within 1 year of the scan. Associations between IGFBP-1 and the adiposity were evaluated with linear regression with square-root of adiposity measures as the outcome. Each subject was weighted by the inverse of the years between CT and closest IGFBP-1 measurement. Results: IGFBP-1 levels were inversely associated with EAT (p =0.007), IAT (p = 0.003) and TTA (p = 0.003) after adjustment for age, sex, body mass index, OPEL/OPUS, diabetic medication, statin use, and high- and low-density lipoprotein levels. BMI explained 27.2% of the variation of TTA (p &lt; 0.001) and IGFBP-1 explained an additional 6% of the variation. There was no association of OPEL/OPUS status with adiposity measures. Conclusion: In conclusion, higher IGFBP-1 was associated with lower cross-sectional TTA, suggesting that IGFBP-1 may be indicative of a favorable cardiometabolic environment in aging. Future studies should evaluate the utility of IGFBP-1, epicardial and thoracic visceral adiposity as indicators of cardiometabolic disease.
Abstract 13536: Cardiac Rehabilitation Enrollment Among Medicare Beneficiaries: Surgical Hospitals Play a Critical Role!
Authors: Quinn R Pack, Aruna Priya, Tara Lagu, Penelope Pekow, Kathleen Mazor, Philip Ades, Peter K Lindenauer
Journal: Circulation (2022)

Introduction: Hospitalization for myocardial infarction (MI), percutaneous coronary intervention (PCI), or cardiac surgery [coronary artery bypass surgery (CABG) or valve surgery] represents a key opportunity to refer and recruit eligible patients to cardiac rehabilitation (CR.) However, little is known about how hospitals influence CR enrollment at the national level. Methods: Using Medicare fee-for-service claims from 2017, we identified all patients with a principal discharge diagnosis of MI, PCI, CABG, or valve surgery. We defined CR enrollment as attending ≥ 1 session within 90 days and calculated hospital-specific CR enrollment rates. To assure stability of our statistical results, we limited our sample to hospitals where cardiac surgery was performed, and then examined the association between patient demographics, procedures, comorbidities, and hospital characteristics on CR enrollment using mixed effects hierarchical logistic regression. We calculated the median odds ratio (MOR) to estimate the extent to which the hospital where a patient was cared for influenced their chance of enrolling in CR. Results: At 3,420 hospitals, we identified a total of 264,970 eligible patients (age 77 ± 8 yrs., 58% male, 85% white, 39% surgical), of which 25% attended CR. While a minority (38%) of hospitals performed cardiac surgery - these hospitals cared for the vast majority (92%) of all eligible patients. At these hospitals, the median CR enrollment rate was low (22%) and varied 10-fold across hospitals at the 10 th and 90 th percentiles (3%, 42%). After multivariable adjustment, the factors most associated with CR enrollment were having cardiac surgery or undergoing PCI (OR 5.8, 2.6 vs. MI respectively), advancing age (OR 0.77 per 5-year increase), low socioeconomic status (OR 0.33), smoking (OR 0.59), or living in the Midwest (OR 2.3 vs. South), p &lt;0.001 for all. The hospital MOR was 2.1, similar in effect size to PCI or Midwest location. Conclusions: In this large national study of older adults, participation rates in CR were low, and the hospital where patients receive their care was strongly associated with CR enrollment. As surgical hospitals care for the majority of all eligible patients, they appear to be the most logical place to focus improvement efforts.
Abstract 13452: Age-Related Increases in Arterial Stiffness is Attenuated With Long-Term Senolytic Therapy in Mice
Authors: Eric Tuday, Torikul Islam, Johntaehwan Kim, Lisa A Lesniewski, Anthony J Donato
Journal: Circulation (2022)

Introduction: It has been established that with advancing age, large elastic arteries (i.e. aorta) demonstrate increased stiffening resulting in detrimental CV health outcomes. Cellular senescence, the permanent arrest of the cell cycle, within the vasculature is characterized by a population of cells that are profibrotic and proinflammatory. Profibrotic and proinflammatory environments have been shown to directly lead to increased large artery stiffness (LAS) with aging. We tested the hypothesis that treatment with the senolytic cocktail dasatinib and quercetin (D&amp;Q) will attenuate LAS in aging mice. Methods: 21-month-old C57Bl/6 mice were treated with D&amp;Q or vehicle via oral gavage on a bi-monthly basis for three months. LAS was measured pre, mid and post treatment by quantifying the aortic pulse wave velocity (aPWV) using a combined Doppler and EKG recording system. Expression of inflammatory genes was assessed by quantitative polymerase chain reaction. Aortic tissue histology was assessed by standard histological methods. Results: D&amp;Q treatment attenuated the age-associated increase in LAS in mice. In the vehicle group, we observed that aPWV increased steadily with age in the vehicle group at 21, 22.5 and 24 months of age (338.9 ± 10.84 cm/s, 351.6 ± 11.53 cm/s, and 369.5 ± 18.57 cm/s respectively, intragroup p=0.004). However, in the D&amp;Q group, we observed a blunted response with corresponding aPWVs (339.5 ± 12.96 cm/s, 322.9 ± 13.9 cm/s, and 342.1 ± 5.67 cm/s; intragroup p=0.7729). Intergroup analysis confirms a significant difference with a p&lt;0.001. Inflammatory markers (TGF-β and TNF-α) were significantly reduced in the D&amp;Q compared to the vehicle group (p&lt;0.05). Extracellular matrix collagen content was lower in aortic tissue from D&amp;Q treated compared to vehicle mice (p&lt;0.01). Conclusions: Chronic, intermittent administration of D&amp;Q prevented the progression of aortic stiffening with advancing age as measured in a longitudinal preclinical mouse study. Aortic inflammatory markers were reduced in the treatment group and similarly the treatment group had attenuated fibrosis vs. vehicle controls. Overall, senolytic therapy represents a potential therapy for aortic fibrosis and age-related increases in large artery stiffness.
Abstract 14419: Cerebrovascular Stability Index is Associated With Motor Development Scores in 6-month Infants With Congenital Heart Disease
Authors: Nhu N Tran, Vidya Rajagopalan, Ashok Panigrahy, Ken M Brady, Jodie K Votava-Smith
Journal: Circulation (2022)

Introduction: Infants with congenital heart disease ( CHD ) have an increased risk for poorer neurodevelopmental outcomes ( NDO ) compared to healthy infants. Impaired cerebrovascular autoregulation ( CA ) may contribute to neurologic abnormalities in CHD infants. This study’s purpose is to assess cerebrovascular stability index ( CSI ), as a surrogate for CA, and its associations with NDO in infants with CHD compared to healthy control infants at 3 early-age timepoints. Hypothesis: We hypothesized that CHD infants who have poorer CSI will have significantly poorer neurodevelopmental outcomes than infants with better CSI. Methods: We conducted a prospective, longitudinal study in CHD infants and healthy controls ( HC ). We measured CSI and NDO at 3 ages (neonatal, 3-month, and 6-month). We performed 3 tilts while measuring cerebral oxygenation via near-infrared spectroscopy. CSI was determined by subtracting the average 2-minute sitting cerebral oxygenation from the 2-minute supine value for each tilt, then averaging the 3 tilt values for each age. The Einstein Neonatal Neurobehavioral Assessment Scale ( ENNAS ) measured neonatal NDO, while the Bayley-3 evaluated the 3 and 6-month NDO. Results: We assessed a total of 28 CHD and 40 HC infants. CHD infants had significantly lower ENNAS scores as neonates (68 CHD vs 83 HC, p&lt;0.001), and at 6-months had lower cognitive (94 CHD vs 100 HC, p=0.04), and motor (86 CHD vs 98 HC, p&lt;0.001) composite scores compared with the HC. However, the other domains did not significantly differ between groups. Linear regression analyses showed that motor development scores in the CHD group improved as CSI improved when adjusted for sex and ethnicity (β=3.64, SE=1.47, p=0.02). CSI did not significantly associate with the cognitive score or NDO for the other ages. Conclusion: We found better CSI significantly associated with higher motor development scores in 6-month old CHD infants, suggesting that impaired CSI may underlie abnormalities of motor development in CHD. Future studies are needed to better understand the mechanism of interaction between CSI and motor development.
Abstract 13818: Health System Integrated Measurement-Based Care Using Patient-Reported Outcomes Assessment in Lower-Extremity Peripheral Artery Disease
Authors: Kim G Smolderen, Lindsey Scierka, Mufti Rahman, Evy van Roij, Brooklyn Bradley, Sameer Nagpal, John Spertus, Alexandria Bascombe, Waleed Tariq Siddiqui, Jeremy A Provance, Gaelle Romain, Shannon Lynch, Pragati Bogra, Eric J Velazquez, Keith Churchwell, Francine Lorusso, Carlos Mena-Hurtado
Journal: Circulation (2022)

Introduction: Peripheral artery disease (PAD) is a chronic disease that requires continuous and individualized disease-management to optimize patients’ symptoms, function and quality of life. Directly capturing patient-reported outcomes (PROs) in routine practice has the potential to increase the patient-centeredness of PAD care. We designed and implemented a system to measure health status within the workflow of a vascular specialty clinic. Methods: In a large academic center, from February 2020 until March 2022, an in-person patient navigation system (Yale PRO-QI) supported by a online data collection workbench was implemented to collect the EQ-5D, Peripheral Artery Questionnaire (PAQ), and VascuQol-6 as part of the outpatient consultations for lower-extremity PAD. Completion rates by month, and domain and summary scores for each PRO were derived per clinical phenotype: new patient/pre-procedural patient, post-procedural/follow-up patient. Results: Of 1071 eligible patient visits, 841 PRO assessments (n=446 unique patients) were completed, for an overall completion rate of 78.5% (monthly completion range 56.4%-100.0%). Patients had a mean age of 70.5±10.2 years, 39.4% were female, 9.6% Hispanics, 14.6% blacks, and 74.7% whites. Of the PROs administered, only the Symptom Stability, Treatment Satisfaction, and Quality of Life subscales of the PAQ were able to discriminate between the clinical phenotypes with differences that reached the minimal clinically important difference threshold of ~10 points ( Figure ). Conclusions: In anticipation of measurement-based care metrics that assess quality of care benchmarks for patient-centered PAD care, our health system integrated PRO workflow had a high response rate, and was able to successfully discriminate between highly symptomatic vs. stable patients as measured by validated disease-specific PRO benchmarks for PAD treatment success.
Abstract 13020: A Pilot Randomized Controlled Trial on a Technology-Based Family-Centered Empowerment Transitional Program Among Heart Failure Patients
Authors: Doris S yu, Chi Wing Wong, Victor Cheng
Journal: Circulation (2022)

Introduction: Heart failure is the most common cause of hospital readmission. While the increased acceptance of mobile health, a novel virtual platform, titled Technology-based Family-centered Empowerment (T-FAME) Program was developed to enhance post-discharge outcomes of HF patients. Hypothesis: The T-FAME was more effective than usual care to enhance self-care, perceived control, HRQoL, and family function of post-discharge HF patients . Methods: From Aug2021 to Jan2022, a pilot RCT randomized 60 post-discharge HF patients (mean age=66.4, SD=2.1; NYHA Grade II/III: 70/30%) to T-FAME or usual care. The 12-week nurse-delivered T-FAME comprises an interactive mobile Apps, which allows i) daily self symptom and clinical monitoring with tailored autonomous nurses' feedback , ii) family-centered goal-setting and attainment plan on self-care , iii) personalized drug education, iv) real-time live chat with nurse, v) video-based HF compass for information navigation. The nurse visited the family for three times and conducted the Calgary family assessment and counseling. Outcome evaluation was done by Self-care Heart Failure Index, Self-care Self-efficacy Scale, Control Attitude Scale, Family Functioning Device, and Minnesota Living with Heart Failure Questionnaire at baseline and post-test. The patients and primary caregivers were interviewed for engagement experience in T-FAME. Results: Two-way analysis of covariance showed significant greater improvement of T-FAME group on self-care maintenance (F=4.762,p=0.033, ƞp2=0.08), management (F=18.223,p&lt;0.001,ƞp2=0.249) and symptom perception (F=9.33,p=0.003, ƞp2=0.145). They reported non-significant greater improvement in self-care self-efficacy, perceived control and HRQL with ƞp2=0.048-0.05, indicating almost medium effect in pilot trial. More families receiving T-FAME reported non-problematic family function (50%) than the control group (16.7%) (p=0.013). The qualitative findings indicated T-FAME is highly acceptable to enable proactive person-centered disease monitoring and management. Conclusions: The preliminary health benefits of T-FAME supports its stringent cost-benefit evaluation in full-scale RCT.